May 9, 2013
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President Obama speaks in Manor, Texas, on Thursday. / LM Otero, AP

by Kelly Kennedy, USA TODAY

by Kelly Kennedy, USA TODAY

WASHINGTON -- The federal government has met its deadlines, tested its system and collected insurance plan information critical to rolling out the 2010 health care law, White House and other federal officials say, despite the rumors of train wrecks, delays and bare-bones health care exchanges rocking Washington.

White House and Health and Human Services Department officials working on implementing the plan say the exchanges will be up and running for enrollment by Oct. 1. They spoke on condition of anonymity because they were not authorized to speak publicly about internal meetings.

Their comments echo those by President Obama and Health and Human Services Secretary Kathleen Sebelius about the exchanges, which are websites where consumers can shop for and buy health insurance.

So far, White House and HHS officials say the government has taken the following steps:

â?¢ Insurers met last Friday's deadline to download their plan information into the exchange system without problems, said Chiquita Brooks-LaSure, deputy director for policy and operations at the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services (CMS). "We are meeting our timelines, and we are on schedule and meeting our benchmarks."

â?¢ HHS officials have determined the federal website for exchanges can support the expected large volumes of traffic. They brought in people from Medicare who already have experience handling large numbers.

â?¢ HHS has started reaching out to populations that will have to buy health insurance on the new exchanges with a push targeted to the neighborhood level. Half of uninsured people ages 18 to 35 are in three states -- including Texas, where Obama spoke Thursday. They will also target Florida and California, where 48% of the 18 to 35 population is Hispanic, and 54% are eligible for federal subsidies. Those are the people hearing the message about the exchanges, rather than people who already have insurance through their employers.

But speculation about an impending disaster has continued because many involved in the health care system say the public hasn't been told about the progress so far.

"We haven't seen anything," said Cheryl Smith, director of Leavitt Partners, which advises states about how to create exchanges. "They might have it ready, but it's anybody's guess."

The concern reached a higher pitch when opponents latched on to comments by Sen. Max Baucus, D-Mont., about the administration's lack of communication being a "train wreck." Baucus, who helped write the law, has since backed off that portrayal. Officials say they have worked to make sure "stakeholders" are informed about progress.

"Because transparency and informing the public with the facts about the benefits of the Affordable Care Act are key to its success, Chairman Baucus is continuing to work with the administration to ensure they communicate with the American people and businesses and he'll continue to do so throughout the implementation process," said Meaghan Smith, Baucus' spokeswoman.

To meet the Oct. 1 deadline to allow consumers to start enrolling in health plans by Jan. 1, officials must make sure the state exchanges communicate with the federal exchange, that federal agencies needed to verify enrollment and subsidy eligibility are linked to the exchanges, and that all privacy and security law requirements are met. Also, insurers must be able to download plan data and receive payments from the government and the consumer, and consumers have to be able to easily navigate a website to buy insurance.

All those systems must be tested to make sure they work together with no glitches, and they must be able to handle millions of people.

"If the administration actually gets done what it says it's going to get done, it's going to be a huge accomplishment," said Jay Angoff, who led initial implementation of the law for HHS. "But when I was there, the one thing HHS held paramount was meeting statutory deadlines. Based on that, I believe they will get it done."

Massachusetts, which passed a state law in 2006 that created a similar program, started its exchange quickly, but it was not as ambitious as the federal one, said Jon Kingsdale, who led the creation of the Massachusetts exchange.

"I'd say they're running very, very hard to be running by Oct. 1," Kingsdale said. "It's going to be close."

Over the summer, HHS will review plans with the insurers and identify what needs to be fixed, as well as work toward integrating the system. The states also have a process in place to review their data.

The agency will also relaunch the exchange website, HealthCare.gov, to support the new exchanges, said Julie Bataille, CMS' communications director.

Testing for another large-scale health program, the Medicare Part D prescription drug benefit, began early, Smith said, and the government spent more time on the project than on the exchanges. Progress on the exchanges was hampered by uncertainty surrounding the Supreme Court case that upheld the law last June.

Despite that delay, Brooks-LaSure said, HHS is on target. While the process with the insurance plans may seem complicated, she said, the government goes through a similar process every year when working with insurers on Medicare plans. Every year, the government makes that information available to consumers through a website.

Alan Cohen, chief strategy officer at Liazon, a company that creates private health exchanges, expressed two concerns that come up often. First, he worries that government can't handle 20 million to 30 million new customers on the exchanges. Second, so many states have decided not to have their own exchanges that the federal exchange will be overwhelmed.

For example, a Congressional Budget Office report said that 7 million people, not 30 million, are expected to enroll in plans through the exchanges next year. That number, the report said, is expected to increase through the years. Second, the federal exchange system can easily expand to include more states, HHS officials say.

While there are concerns that enough people won't learn the details of how to buy insurance, the government does not want to deliver the message to the wrong people or too early, said Tara McGuinness, a senior White House communications adviser in charge of the law.

They don't want people to think they can sign up for exchanges now, just as they wouldn't want to tell people in May where to vote if the election isn't until November, she said. Instead, the push will begin in earnest in the summer, she said.

On Thursday, Obama was in Austin touting the Affordable Care Act and an announcement that the government will give $150 million to health centers to help enroll people in the exchanges.

As they work to tap whatever money is available to promote exchanges, McGuinness said, the administration will also emphasize parts of the law that have already started, such as the elimination of out-of-pocket costs for annual exams or allowing children up to age 26 to remain on their parents' insurance plans.